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HomeMy WebLinkAboutCROWN CASTLE INTERNATIONAL - INSURANCE CERTIFICATE (2)CERTIFICATE OF LIABILITY INSURANCE page 1 of 2 03/28/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Willis of Pennsylvania, Inc. c/o 26 Century Blvd. P. O. Box 305191 PHONE 8779457378 FAX ggg_467-2378 - -!- - EA DR -MAIL certificates@willis.com Nashville, TN 37230-5191 INSURER(S)AFFORDINGOOVERAGE NAIC # INSURERA:Federal Insurance Company 20281-005 INSURED Crown Castle International INSURERB:Travelers Property Casualty Co of Amer 25674-001 INSURERC:Berkshire Hathaway Specialty Insurance Co 22276-001 See Attached Named Insured List 1220 Augusta Dr. Suite 600 Houston, TX 77057 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 25324347 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DDL SUB POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR 7021-02-28 4/1/2017 4/1/2018 EACH OCCURRENCE $ 1,000,000 ppppFf�pp((;;�ETT ENTED PREMf5E5QEaoccurence) $ 1,000,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 11000,000 GEN1 AGGREGATE LIMIT APPLIES PER: POLICY PROJECT F] LOC OTHER: GENERALAGGREGATE $ 2,000,000 X PRODUCTS- COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY TC2JCAP-474M9749-17 4/l/2017 4/1/2018 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ $ PROPERTYDAMAGE (Per accident) $ C X UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE 47-UMO-303445-01 4/1/2017 4/l/2018 EACHOCCURRENCE $ 5 00,000 AGGREGATE $ 5,000,000 DED X RETENTION$ 25,000 $ B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROP RIETOR/PARTNER/EXECUTIVE � OFFICER/MEMBER EXCLUDED? ((Mandatory in NH) (fyes,describeunder DESCRIPTION OF OPERATIONS below N/A TC2JUB-474M9694-17 TRKUB-474M9701-17 4/1/2017 4/1/2017 4/1/2018 4/1/2018 X E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: 877023 See Attached CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FORT COLLINS, CITY OF AUTH IZEDREPRES ATIVE PO BOX 580 ATTN EDNA HOERNICKE FORT COLLINS, CO 80522 Coll:5053204 Tpl:2134149 Cert:25324347©1988-2015ACORD CORPORATION. All rights reserve d. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 713115 LOC#: A� ADDITIONAL REMARKS SCHEDULE Page_2-of _2_ AGENCY Willis of Pennsylvania, Inc. POLICY NUMBER See First Page CARRIER See First Page DDITIONAL REMARKS NAIC CODE NAMED INSURED Crown Castle International See Attached Named Insured List 1220 Augusta Dr. Suite 600 Houston, TX 77057 EFFECTIVEDATE: See First THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25___— FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Certificate Holder is included as an Additional Insured under the General Liability, Automobile Liability and Umbrella/Excess Liability policies as their interest may appear and as required by written agreement and only with respect to the liability arising out of the operations performed by or on behalf of the Named Insured. General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation include a Waiver of Subrogation in favor of the Additional Insured when required by written contract and as permitted by law but always subject to the policy terms, conditions and exclusions as permitted by law. ACORD101 (2008/01) Coll:5053204 Tpl:2134149 Cert:25324347©2008ACORD CORPORATION. All rlgntsreservea. The ACORD name and logo are registered marks of ACORD